“We need to view it now as an urban disease as well as a rural one – and therefore one requiring a different order of magnitude of preparations, including vaccines,” he said.
Merck’s experimental Ebola vaccine, known as rVSV-ZEBOV, is the furthest ahead in development. Another potential vaccine being developed by Johnson & Johnson could also eventually become part of the stockpile, global health officials say.
Congo’s two Ebola outbreaks this year illustrate the shifting nature of the threat.
The first was relatively contained, infecting up to 54 people and killing 33 of them in an area of DRC’s Equateur Province that is remote and sparsely populated.
Several of the eight outbreaks before this one in Congo – including one in 2014 and another in 2017 both also in Equateur – were also quickly contained and limited in size.
But this year’s second outbreak in Congo – and the country’s tenth since the virus was first identified there in 1976 – is concentrated not in rural villages but in urban areas of the North Kivu and Ituri provinces.
It has already infected more than 450 people, killed more than 270, and last month spread to Butembo, a densely populated city of about one million.
This kind of prospect means global health emergency responders must “review our assumptions around Ebola”, Salama said. “If it were to take off in Butembo, or Goma, or, even worse, Kinshasa, we’d be talking about a totally different issue in terms of … vaccine supplies required.”